Healthcare has become something of a hard science, if the focus on data and numbers is any indication. It would seem that the research, the endless reporting and spreadsheets of healthcare administration, has served to at least shed light on the problems healthcare is currently facing as an industry - but the fix isn’t likely to be in black and white.

As 2014 draws to a close, many of us in the healthcare industry are looking back at the year we’ve had and reflect on what worked, what needs to change and what we can expect for 2015. As an industry, healthcare saw a continued move towards accountable care, shared decision making, value-based purchasing and patient satisfaction measures. Buzzwords abound, there was a lot for everyone - providers, patients and payers - to juggle this year. And it looks like the trend is apt to continue into 2015.

We hear a lot about bi-partisanship in politics - but what about healthcare? Sometimes it seems like the payers and the providers, the administrative and the clinical, are across the aisle from one another in more ways than one, and it brings to mind the challenges faced by politicians who just can’t see from the other side’s perspective. While politics shoulders many competing agendas, when it comes to healthcare the bottom line is the same no matter where you are: good health for the best price. This is even true of the patient’s themselves, who are becoming more and more concerned with the cost of the services they receive - and using the internet to find out if there’s a better “bargain” on care somewhere else.

You might be thinking - “Just five challenges?!” and it’s true that the healthcare industry is facing many challenges at the moment. Five of them, however, are most specific to hospitals. We often think of hospitals as the “front lines” of healthcare, and while it may be true that the majority of practicing physicians, nurses and allied health professionals find employment there, new data shows that one vital piece of the hospital picture might be missing: patients.

The Affordable Care Act will allow 30-40 million new patients to have access to hospital services - particularly emergency room services. ERs are already notoriously overrun and patient dissatisfaction about wait times and care quality are abound. With even more patients expected to grace the department than ever before, how can your ED prepare?

In the wake of Ebola, healthcare systems worldwide are focusing more than ever on defining - and refining - their population health initiatives. Smart thinking on multiple accounts, if you think about where we’re headed in terms of healthcare reform. Hospitals that are moving towards population health initiatives now will be far better prepared for the overall shift to accountable care that’s on the horizon.

When was the last time your organization performed a SWOT analysis? If you aren’t familiar with SWOT (strengths, weaknesses, opportunities and threats) it’s a widely used strategy in many industries, not just healthcare, for identifying areas for improvement. You can break SWOT down even further:
Strengths: What sets your hospital apart from all the rest? What can you offer that makes you competitive?
Weaknesses: What puts your hospital and employees at a disadvantage compared to other hospitals? What of these factors can you change?
Opportunities: How can you show your strengths to others?
Threats: What could cause big trouble for your hospital or employees?

In the light of the first-ever confirmed Ebola case in the United States, questions of procedure and preparedness are humming throughout all fifty states. The patient, a Liberian man who had left Africa and arrived in Texas before symptoms began, has become the center of media attention this week. So to, has the Texas Health Presbyterian Hospital become something of a media darling - in so far as they are being heavily scrutinized.

October 1st of last year, CMS cracked down on readmission rates for hospitals nationwide, handing out millions of dollars in penalties. The Affordable Care Act put these measures into place in order to curb the problem of readmissions, which are not only costly, but reflect an overall poor population health in the U.S. - especially for those patients with chronic conditions.
For FY ‘14, 2% was withheld from payments per the guidelines for penalties. By 2015, the rate of withholding for penalties is expected to top 3%. In addition to the higher payments, there will also be additional diagnoses included in the readmission criteria list - it began with heart attacks, pneumonia and heart failure and will now expand to include COPD and complications from chronic lung conditions.

When it comes to patient safety, the best way to be prepared is to develop evidence-based plans and strategies to guide patients through the healthcare system. These plans are called clinical pathways.
Developing Clinical Pathways
Clinical pathways are being developed in hospitals nationwide to help physicians move patients through the hospital. They are designed by the hospital, for the patients, and they have many benefits.

"BHM provides consultation and direct clinical oversight to East Carolina Behavioral Health as a delegated authority for clinical peer review and physician services. We have been extremely satisfied, and value the organization’s depth and breadth of knowledge. BHM continues to exceed our expectations."

Cindy Ehlers,
V P Clinical Operations, Trillium (formerly ECBH)

"6 of the top 10 largest health plans* entrust BHM for behavioral health peer reviews.